Dietary intake, body composition and micronutrient profile of patients on maintenance hemodialysis attending Kiruddu National Referral Hospital, Uganda: A cross sectional study.

Patients on maintenance hemodialysis are at a great risk for altered nutritional status, characterized by protein energy wasting and micronutrient deficiency due to medication interactions and dietary restrictions. This study determined the dietary intake, micronutrient profile and body composition of patients on maintenance hemodialysis at Kiruddu National referral hospital (KNRH), Uganda. A cross sectional study was done among adult CKD patients on maintenance hemodialysis therapy at KNRH. Data concerning patients' demographics, clinical history and dietary intake was obtained using interactive and quantitative food frequency questionnaires. Body composition was obtained using the TANITA BC-351, Japan weighing Bathroom scale and anthropometric measurements using standard methods and procedures. Serum micronutrient profile assessment was done using the COBAS Auto analyzer. Data analysis was done using the SPSS software version 20. T-test was used to make comparisons and logistic regression analysis was done to check for any correlations. A P-value of < 0.05 was considered statistically significant. Among the 63 hemodialysis patients, 38% were female, with a median duration of hemodialysis of 12 months and the overall age range of patients was 31-40 years. Majority (92.1%) of the patients had hypertension. Carbohydrates like maize flour were highly consumed, in addition to eggs among the proteins on the daily basis. Fruits and vegetables were not highly consumed. Regarding body composition; 75% of the study participants had normal Body mass Index (BMI), the mean muscle mass was 51.94±8.68, body fat was 15.25±7.35, bone mass was 2.77±0.46 and body water was 62.04±9.06. Patients had deranged micronutrient levels especially for Vitamin D, Potassium and phosphorus. In conclusion, hemodialysis patients at KNRH, have altered nutritional status as evidenced by altered body weight for some patients and deranged micronutrient levels. We recommend that hemodialysis patients should be regularly assessed for nutritional status, appropriately treated and educated about their nutritional status.

Clinical associates and access to healthcare in the Eastern Cape province of South Africa.

BACKGROUND:  Clinical associates (ClinAs) were introduced into South Africa as part of the remedy for the severe shortage of healthcare workers in rural areas. Walter Sisulu University (WSU) graduated 100 ClinAs between 2011 and 2014. These ClinAs were expected to be based at district hospitals where they would work under the supervision of doctors, reduce the workload of doctors and increase access to healthcare in the Eastern Cape. AIM:  This study aimed to examine the role played by ClinAs in healthcare delivery in Eastern Cape district hospitals, and to determine whether the training of ClinAs adequately prepared them for this role. SETTING:  The study was conducted in the Eastern Cape province of South Africa amongst ClinAs who graduated from WSU between 2011 and 2014, and healthcare workers from Madzikane KaZulu Memorial Hospital. METHODS:  This was an exploratory cross-sectional mixed methods study with a convergent design. Surveys and in-depth interviews were conducted amongst ClinAs, nurses, doctors and one pharmacist. Both qualitative and quantitative data were analysed and reported. RESULTS:  Clinical associates are seen to improve the workload of doctors, and to increase access to healthcare. Thirty-four percent of ClinAs were no longer contributing to healthcare in the Eastern Cape. CONCLUSION:  Clinical associates are making a significant contribution to access to healthcare in the Eastern Cape. Their supervision regimen needs to be revisited and factors that contribute to the attrition of ClinAs in the Eastern Cape need to be addressed.

The protective effect of aqueous extract of Typha capensis rhizomes on cadmium-induced infertility in rats.

Background Typha capensis is one of the medicinal plants commonly used to manage male fertility problems. The objective of the present study was to assess its fertility-promoting effects in a rat model of cadmium-induced infertility. Methods A total of 30 male Wister rats were randomly divided into five groups of six animals each. Animals of group I, which served as control, were administered with cadmium chloride (CdCl2; 2.5 mg/kg) and normal saline (2 mL/kg). Group II was served with 0.5 mL normal saline only. Animals of groups III-V were treated with CdCl2 (2.5 mg/kg) plus T. capensis extract at doses of 100, 200, and 400 mg/kg, respectively. Animals were sacrificed under sedation. Testes and epididymal weights and sperm count were determined. Histological assessment of the testes was conducted. Results T. capensis at any dose did not improve (p > 0.05) testicular and epididymal weights compared with those of the CdCl2-exposed control group. Histology revealed moderate necrosis in the same group. T. capensis modestly increased the sperm count by 14%, 31%, and 35%, for groups treated with the extract at doses 100, 200, and 400 mg/kg, respectively, when compared with the CdCl2 control group, although the differences were not significant statistically (p > 0.05). Conclusions Results of our study demonstrated that T. capensis can neither offer protective effects against oxidative stress nor promote fertility in an animal model of cadmium-induced infertility.

Predictors of recovery in moderate to severe traumatic brain injury.

OBJECTIVETraumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Clinical outcomes in TBI are determined by the severity of injury, which is dependent on the primary and secondary brain injury processes. Whereas primary brain injury lesions are related to the site of impact, secondary brain injury results from physiological changes caused by oxidative stress and inflammatory responses that occur after the primary insult. The aim of this study was to identify important clinical and biomarker profiles that were predictive of recovery after moderate to severe TBI. A good functional outcome was defined as a Glasgow Outcome Scale (GOS) score of ≥ 4.METHODSThis was a prospective study of patients with moderate to severe TBI managed at the Nelson Mandela Academic Hospital during the period between March 2014 and March 2016. Following admission and initial management, the patient demographic data (sex, age) and admission Glasgow Coma Scale score were recorded. Oxidative stress and inflammatory biomarkers in blood and CSF were sampled on days 1-7. On day 14, only blood was sampled for the same biomarkers. The primary outcome was the GOS score-due to its simplicity, the GOS was used to assess clinical outcomes at day 90. Because of difficulty in performing regular follow-up due to the vastness of the region, difficult terrain, and long travel distances, a 3-month follow-up period was used to avoid default.RESULTSSixty-four patients with Glasgow Coma Scale scores of ≤ 12 were seen and managed. Among the 56 patients who survived, 42 showed significant recovery (GOS score ≥ 4) at 3 months. Important predictors of recovery included antioxidant activity in the CSF (superoxide dismutase and total antioxidant capacity).CONCLUSIONSRecovery after TBI was dependent on the resolution of oxidative stress imbalance.

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study.

BACKGROUND: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. METHODS: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet's Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. RESULTS: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds. CONCLUSIONS: These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

Experiencia educativa de estudiantes de segundo año de Medicina en una universidad sudafricana, 2011-2014 / Educational experience of second-year medical students from a South-African university (2011-2014)

Introducción: la educación centrada en la comunidad es un componente esencial del diseño curricular de la carrera de Medicina. En el segundo año, los estudiantes permanecen durante tres semanas en hospitales rurales y desde ellos van a las clínicas, centros de salud comunitaria y a las casas de la comunidad. Objetivos: identificar evidencias del cumplimiento de los objetivos de aprendizaje de esta actividad en los diarios de campo de los participantes. Métodos: se hizo el análisis cuali-cuantitativo del contenido de los diarios de 58 estudiantes. La información se agrupó de acuerdo a los tres escenarios de aprendizaje, y en un segundo análisis emergieron las siguientes categorías: determinantes que afectan la salud de la población, enfermedades que provocaron que los usuarios acudan a los centros de salud, así como información sobre el funcionamiento de estas instituciones. Resultados: la pobreza, el desempleo, el hábito de fumar y el alcoholismo fueron los determinantes de la salud que los estudiantes mencionaron con más frecuencia. Mientras que la malnutrición, el VIH/SIDA, el embarazo precoz y abandonar el tratamiento fueron las causas que obligaron a los usuarios a solicitar servicios de atención tanto en el nivel primario como en el secundario. Destacaron también el protagonismo del personal de enfermería en los servicios que ofrecen los centros de salud, así como el rol de todos los departamentos (médicos y no médicos) en el funcionamiento del hospital. Conclusiones: las categorías que emergieron de los diarios reflejan que los objetivos educacionales se cumplieron y que fue una experiencia rica en relaciones sociales y oportunidades para aprender(AU)

Introduction: Community-centered education is an essential component of curricular design for the medical major. In the second academic year, students stay for three weeks in rural hospitals, from which they go to clinics, community health centers and community houses. Objectives: To identify evidence of compliance with the learning objectives of this activity in the home visits plans of the participants. Methods: The qualitative and quantitative analysis of the content was carried out of the home visits plan of 58 students. The information was grouped according to the three learning settings, and a second analysis derived in the following categories: determinants that affect the health of the population, diseases that caused users to go to health centers, as well as information about the functioning of these institutions. Results: Poverty, unemployment, smoking and alcoholism were the health determinants that the students mentioned most frequently. While malnutrition, HIV/AIDS, early pregnancy and abandoning treatment were the causes that forced users to request care services at both the primary and secondary levels of healthcare. They also highlighted the role of the nursing staff in the services offered by health centers, as well as the role of all departments (doctors and non-doctors) in the running of the hospital. Conclusions: The categories derived from the home visits plan reflect that the educational objectives were fulfilled and that the experience was a fruitful regarding the social relations and opportunities to learn(AU)

Experiencia educativa de estudiantes de segundo año de Medicina en una universidad sudafricana, 2011-2014 / Educational experience of second-year medical students from a South-African university (2011-2014)

Introducción: la educación centrada en la comunidad es un componente esencial del diseño curricular de la carrera de Medicina. En el segundo año, los estudiantes permanecen durante tres semanas en hospitales rurales y desde ellos van a las clínicas, centros de salud comunitaria y a las casas de la comunidad. Objetivos: identificar evidencias del cumplimiento de los objetivos de aprendizaje de esta actividad en los diarios de campo de los participantes. Métodos: se hizo el análisis cuali-cuantitativo del contenido de los diarios de 58 estudiantes. La información se agrupó de acuerdo a los tres escenarios de aprendizaje, y en un segundo análisis emergieron las siguientes categorías: determinantes que afectan la salud de la población, enfermedades que provocaron que los usuarios acudan a los centros de salud, así como información sobre el funcionamiento de estas instituciones. Resultados: la pobreza, el desempleo, el hábito de fumar y el alcoholismo fueron los determinantes de la salud que los estudiantes mencionaron con más frecuencia. Mientras que la malnutrición, el VIH/SIDA, el embarazo precoz y abandonar el tratamiento fueron las causas que obligaron a los usuarios a solicitar servicios de atención tanto en el nivel primario como en el secundario. Destacaron también el protagonismo del personal de enfermería en los servicios que ofrecen los centros de salud, así como el rol de todos los departamentos (médicos y no médicos) en el funcionamiento del hospital. Conclusiones: las categorías que emergieron de los diarios reflejan que los objetivos educacionales se cumplieron y que fue una experiencia rica en relaciones sociales y oportunidades para aprender(AU)

Introduction: Community-centered education is an essential component of curricular design for the medical major. In the second academic year, students stay for three weeks in rural hospitals, from which they go to clinics, community health centers and community houses. Objectives: To identify evidence of compliance with the learning objectives of this activity in the home visits plans of the participants. Methods: The qualitative and quantitative analysis of the content was carried out of the home visits plan of 58 students. The information was grouped according to the three learning settings, and a second analysis derived in the following categories: determinants that affect the health of the population, diseases that caused users to go to health centers, as well as information about the functioning of these institutions. Results: Poverty, unemployment, smoking and alcoholism were the health determinants that the students mentioned most frequently. While malnutrition, HIV/AIDS, early pregnancy and abandoning treatment were the causes that forced users to request care services at both the primary and secondary levels of healthcare. They also highlighted the role of the nursing staff in the services offered by health centers, as well as the role of all departments (doctors and non-doctors) in the running of the hospital. Conclusions: The categories derived from the home visits plan reflect that the educational objectives were fulfilled and that the experience was a fruitful regarding the social relations and opportunities to learn(AU)

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

PURPOSE: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. METHOD: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. RESULTS: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. CONCLUSIONS: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

Defining Sub-Saharan Africa's Health Workforce Needs: Going Forwards Quickly Into the Past Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".

Recent proposals for re-defining the roles Africa's health workforce are a continuation of the discussions that have been held since colonial times. The proposals have centred on basing the continent's healthcare delivery on non-physician clinicians (NPCs) who can be quickly trained and widely distributed to treat majority of the common diseases. Whilst seemingly logical, the success of these proposals will depend on the development of clearly defined professional duties for each cadre of healthcare workers (HCW) taking the peculiarities of each country into consideration. As such the continent-wide efforts aimed at health-professional curriculum reforms, more effective utilisation of task-shifting as well as the intra - and inter-disciplinary collaborations must be encouraged. Since physicians play a major role in the training mentoring and supervision of physician and non-physician health-workers alike, the maintenance of the standards of university medical education is central to the success of all health system models. It must also be recognized that, efforts at improving Africa's health systems can only succeed if the necessary socio-economic, educational, and technological infrastructure are in place.

Prevalence of metabolic syndrome in adolescents living in Mthatha, South Africa.

OBJECTIVE: Metabolic syndrome (MetS), defined as the clustering of three of five risk factors (hypertension, obesity, triglyceridemia, dyslipidemia and hyperglycemia), is being increasingly mentioned among children and adolescents despite there being no consensus on how it should be defined in this set of population. Furthermore, very few studies have focused on MetS in children and adolescents in sub-Saharan populations. This study, therefore, aimed at determining the prevalence of the MetS and contributing risk in adolescents living in Mthatha, South Africa. RESEARCH DESIGN AND METHODS: Four hundred and ten adolescents (age range: 13-18 years, both sexes) were recruited into this cross-sectional study. In addition to a lifestyle questionnaire being administered, anthropometric measurements (weight, height and waist circumferences) were carried out for each participant. Fasting venous blood was collected for lipid profile and blood glucose assessments. Blood pressure was also measured. MetS was assessed using appropriate diagnostic criteria for children and adolescents. RESULTS: Complete data sets were collected from 371 participants. Females showed an elevation in the risk factors for MetS. Of the 371 participants, 40.2% were overweight/obese (47.5% females; 22.5% males). MetS was diagnosed in 3.1% female participants compared with 6.0% in male participants. CONCLUSIONS: More risk factors for the MetS are seen among the overweight/obese as compared to lean adolescents. Given the fact that childhood overweight/obesity often continues into adulthood, it is important to address the causes of increased risk for MetS earlier in life to prevent the development of disease in adult life.

[How do students who feel "not free to participate" perceived their tutorial sessions in problem based learning?]. / La inhibición a participar y su nexo con percibir una tutoría diferente.

BACKGROUND: Verbal interactions are paramount to develop cognitive and social skills of students taught using problem based learning in small group tutorials. Responses to a questionnaire showed that 27% of second year medical students did not feel free to participate in their groups AIM: To explore if these students may have different perceptions respect to their peers, regarding the functioning of their tutorials. MATERIAL AND METHODS: The answer to the item "feel free to participate" was the criterion to allocate students in two groups, study (n = 25) and control (n = 66). The means of the perceptions were compared between groups in the 15 items' questionnaire. RESULTS: Students in the study group had different perceptions in eight of the items. These students enjoyed and considered interesting the topics addressed in the tutorials less frequently. Also they did not study all learning issues, did not always understand the case and foresaw less opportunities to participate in their groups. CONCLUSIONS: Quiet students perceived tutorials different than their more active peers. Those differences concerned motivation and a mixture of cognitive (individual) and social (rest of the group) strategies that were not conducive to build a suitable learning environment for those students in their respective tutorial groups.

Prevalence of hypertension and pre-hypertension in 13-17 year old adolescents living in Mthatha - South Africa: a cross-sectional study.

BACKGROUND: Hypertension is one of the most common risk factors for cardiovascular diseases (CVDs), yet not much effort is being invested in early diagnosis and control of the condition in susceptible children. The aim of this study was to,investigate the prevalence of pre-hypertension and hypertension in peri-urban school-attending adolescents and explore the relationship between blood pressure and selected anthropometric measurements. METHODS: A cross-sectional study of adolescents aged 13-17 years was performed. Data on height, weight, waist and hip circumferences as well as blood pressure were collected from all participants. Body mass index (BMI) and blood pressure percentiles were calculated. Results: The overall prevalence of obesity was 20.4% while the prevalence of hypertension and pre-hypertension was 21.2% and 12.3%, respectively. The prevalence of hypertension and pre-hypertension in males was 22.0% and 13.6% compared to 20.9% and 16.5% in females, respectively. Both conditions were associated with higher BMI in both girls and boys. While mean systolic blood pressure (SBP) was positively associated with higher BMI and waist circumference (WC) in males and females, it correlated negatively with hip circumference (HC) in males. On the other hand, mean diastolic blood pressure (DBP) correlated better with HC in males but only weakly in females. CONCLUSION: Adolescent learners in Mthatha had a high prevalence of hypertension and pre-hypertension which were associated with overweight and obesity. Results highlight the urgent need for screening in view of early detection and implementation of intervention strategies to prevent a high incidence of CVDs in this country.

24-Hour Measurement of Gastric pH in Rural South Africa.

Background. Previous studies have established norms of 24-hour gastric pH profiles for western countries. This study was designed to establish the pattern for a rural African population with a high incidence of oesophageal cancer. Methods. After lower oesophageal manometry a probe was placed 10 cm distal to the lower oesophageal sphincter. We carried out 24-hour ambulatory monitoring of gastric pH on 59 healthy subjects. This was satisfactorily completed on 26 female and 18 male (age 21-64, median 35) subjects in the Transkei region of South Africa. Results. The mean 24 hour gastric pH was 2.84 and the mean night-time pH was 3.7. 40 volunteers recorded a night-time pH reaching over 4. 33 volunteers recorded a night-time pH over 7. Night-time alkalinisation was present for 136.4 minutes (25th centile 22.8, 75th centile 208.1) at pH4 or over, and 79.3 (2.5, 122.7) minutes at pH7 or over. Episodes of rapid alkaline rise were 17 (10, 47). 21.1% of these occurred while supine. 35 of 36 tested subjects were positive for H. pylori IgG. Conclusion. Gastric alkalinisation is common in Transkei, at a higher pH than that reported in other studies, and is sustained longer. Nighttime alkalinisation is frequent. This suggests a high level of duodenogastric reflux.

Student Opinions on Factors Influencing Tutorials at Walter Sisulu University, South Africa.

INTRODUCTION Problem-based learning harmonized with education in and for the community is the cornerstone of the curriculum for the undergraduate medical degree at Walter Sisulu University, Mthatha, South Africa. In tutorials, students construct knowledge and learn to work collaboratively while interacting with one another in their search for solutions to a pedagogically modeled health issue based on a patient. Problems cover students' needs defined by the learning cycle of the second year medical curriculum, organized into four learning blocks. OBJECTIVES Determine student perspectives on which factors affect tutorial group functioning and detect the reported presence of these factors in the four learning blocks comprising the second year of medical studies at Walter Sisulu University. METHODS Twenty second-year medical students were chosen by stratified random sampling and assigned to two focus groups. One group discussed factors that foster smooth functioning of the tutorial group; the other focused on factors hindering effective group work. Later, in a joint session, 17 items previously identified by both groups were selected and included in a survey given to all 97 students at the end of second year. The survey assessed presence of each item in 0, 1, 2, 3 or 4 of the learning blocks. RESULTS Survey response was 93.8%. Mean reported presence of factors that influenced tutorials in the four learning blocks was 2.71 (SD 0.31) for the social dimension, 3.02 for motivational (SD 0.02), 3.00 for cognitive (SD 0.42), and 2.22 for self-directed learning (SD 0.79). CONCLUSIONS Tutorial group performance at Walter Sisulu University is positively influenced more by motivational and cognitive factors than by social and self-directed learning factors. Social dimensions should be prioritized when training tutors and self-directed learning stressed for students. The poor productivity of extra-tutorial group discussions suggests the need for a critical evaluation of this activity. KEYWORDS Problem-based learning, problem-based curriculum, active learning, medical education, tutorial groups, South Africa.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

CONTEXT: Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. METHODS: A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. RESULTS: The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). CONCLUSIONS: Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.

Addressing social responsibility in medical education: the African way.

Indigenous sub-Saharan societies have, over the millennia, lived and socialised within the unwritten 'rules' of the 'Ubuntu' or similar philosophies that emphasises holistic 'humanness', and which is a form of 'social responsibility'. This article looks into some relevant social responsibility aspects of medical education in the South African context, with particular emphasis on how these aspects have been addressed. Apartheid was, by its very nature, incompatible with social responsibility for the majority of South Africans, but one medical school that was a non-complicit product of apartheid succeeded in fulfilling a socially responsible mission. Thus, this article implicitly identifies what South Africa, Africa and the global Health Professions Education community could learn from these trail-blazing experiences.

Molecular basis for maize as a risk factor for esophageal cancer in a South African population via a prostaglandin E2 positive feedback mechanism.

The incidence of squamous cancer of the esophagus varies up to a hundredfold in different regions of the world. In Transkei, South Africa, a particularly high incidence of the disease is observed. We have previously proposed an association between a maize-rich diet and elevated levels of intragastric prostaglandin E2 production (PGE(2)). Here we investigate the molecular mechanisms by which a high-maize diet could lead to increased incidence of squamous cancer of the esophagus. We confirm that levels of PGE(2) are high (606.8 pg/ml) in the gastric fluid of individuals from Transkei. We also show that treatment of esophageal cells with linoleic acid, which is found at high levels in maize and is a precursor to PGE(2), leads to increased cell proliferation. Similarly, treatment of cells with PGE(2) or with gastric fluid from Transkeians also leads to increased proliferation. Our data suggest that the high levels of PGE(2) associated with a maize-rich diet stimulate cell division and induce the enzyme COX 2, resulting in a positive feedback mechanism that predisposes the esophagus to carcinoma.

Investigation of the antinociceptive and anti-inflammatory properties of Heteromorpha arborescens (Apiaceae).

Heteromorpha arborescens belongs to the family Apiaceae. It is commonly known as the parsley tree. One of its uses in the Eastern Cape Province of South Africa is for the treatment of abdominal pains. The therapeutic effects of the methanolic and aqueous root extracts of H. arborescens were investigated at two dose levels respectively on experimental models of pain and inflammation in rodents. The antinociceptive activity was evaluated using the hot-plate, abdominal constriction and formalin tests. The anti-inflammatory properties of these extracts were assessed using albumin and carrageenan as phlogistic agents. Both extracts produced significant (P<0.05, P<0.01) inhibition of thermal nociception induced by a hot plate. On chemical nociception induced by intraperitoneal acetic acid and subplantar formalin injection, both extracts significantly (P<0.05, P<0.01) decreased the number of writhing episodes and the licking time in a dose dependent manner. Treatment with the extracts at the same doses produced a significant (P<0.05, P<0.01) pain inhibition of the carrageenan induced inflammatory pain. Similarly, both extracts produced a significant (P<0.05, P<0.01) reduction of edema induced by albumin and carrageenan. These results suggest that both extracts of H. arborescens may act by inhibition of the mediators of inflammation. These findings seem to justify the use of the plant in traditional medicine in the management of pain and inflammation related diseases.

Medical schools in sub-Saharan Africa.

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.